Once a claim is submitted within SimplePractice it is scrubbed for errors and then sent to the payer. For one reason or another, you may need to resubmit the claim, whether it is due to a rejection, a denial, or there was a mistake you noticed after submission. This guide will detail the differences of submitting an original and when you should be submitting a corrected claim.
First, each payer can have unique rules/requirements to submitting corrected claims so it is always best to follow up with they payer to see if they have any. For example, most state Medicare payers do not accept resubmissions and want all claims to be submitted as Originals.
For a general rule of thumb, a claim should always be submitted as an original claim when the original claim was automatically rejected due to invalid data. This means the claim was rejected prior to the payer processing the claim and a corrected claim will not work.
A corrected claim tells the payer that you have sent the claim to them before, but that you would like it to be re-adjudicated. This can mean that you are sending them information that was not provided previously or that you think they processed the original claim incorrectly. If the original claim was never processed by the payer, you do not have to submit the claim as a resubmission.
To successfully submit a corrected claim, you will need the payer claim number of the original claim which is sometimes sent by the payer but can always be found on the Explanation of Benefits (EOB) or Electronic Remittance Advice (ERA). Submitting a correct claim can easily be done by following these steps:
- From your Calendar homepage go to Billing > Insurance > Claims tab.
- Open the claim that needs to be corrected and resubmitted.
- Click Edit to Resubmit.
- You can now edit the claim and make the necessary corrections.
- Next, scroll down to Box 22 and make sure that the Resubmission option is checked.
Finally, you’ll input the Payer Claim Number in the Original Ref. No. field. The Payer Claim Number is assigned directly by the Insurance Payer. This number will auto-populate to this field if a Payer Claim Number has been received by SimplePractice. However, we always recommend checking the Payer Claim Number on the corresponding ERA to ensure that it matches. If a Payer Claim Number has not been received, please input the original claim number that can be found on the EOB you received from the payer.
The Payer Claim Number can be found by clicking Claim Details at the top of the claim and scrolling down to Insurance Payment Report. Here's an example of what this looks like:
For additional information, please refer to this guide: Payer Claim # vs. Clearinghouse Reference #.